Healthcare Provider Details

I. General information

NPI: 1386219608
Provider Name (Legal Business Name): TEAGAN S MARTEL MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

356 VT ROUTE 14
EAST CALAIS VT
05650-8271
US

IV. Provider business mailing address

356 VT ROUTE 14
EAST CALAIS VT
05650-8271
US

V. Phone/Fax

Practice location:
  • Phone: 802-793-7546
  • Fax: 802-225-6090
Mailing address:
  • Phone: 802-793-7546
  • Fax: 802-225-6090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number097.0134428
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: